Stanley Feld M.D.,FACP,MACE
Why do physicians seem resistant to the use of Electronic Medical Records (EMRs)? The answer is there are at least three barriers to adoption of EMRs that healthcare policy wonks seem to ignore that must be cured.
The New York Times reported on a survey published in the New England Journal of Medicine that less than 9% of physician in small physician office practices use EMRs? The major barrier is these small physician practices cannot afford to buy them and do not know which EMR to buy.
There are different sized medical practice groups in the United States. However, more than 50% of physicians practice in groups of one to three physicians. The survey points out that the smaller the group the less likely they are to have an EMR.
I have described the ideal electronic medical record. I have also emphasized that the patient should own the record. Its distribution should be exclusively in the hands of the patient. Technology exists to create a fabulous electronic medical record. The data generated could increase the quality of medical care and decrease medical errors. The result could be an enormous decrease in the costs to the healthcare system.
So why is the medical community slow to adopt the EMR? The government sponsored survey points to two contradictory conclusions.
The New England Journal of Medicine published survey found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care.
Dr. Peter Masucci, a pediatrician in Massachusetts, said shifting to computerized records helped improve his patient care.
The meaning of the concept of quality medical care should be obvious but is complex. The judgment of quality medical care by a computer program is frequently wrong. This, in my opinion, is the major problem with the present Pay for Performance fad. It is an attempt at a judgment of quality that results in a punitive action against the doctor rather than being an educational experience for him or her.
Physicians in private practice have been slow to adopt EMR’s for at least three reasons.
1. They do not have the financial resources to spend $25,000 to $80,000 per physicians to purchase an EMR. The range of cost for an EMR implies differences in quality and capability of the various EMRs on the market. Many physicians have made investments in EMRs only to find them to be deficient in many areas. The initial investment does not include a yearly maintenance service contracts or updates. Many EMRs lack adequate software support. Physicians do not have the skill or want to devote the time to figure out the best deal.
2. A second reason is the lack of financial incentives to purchase an EMR. The EMR might help the healthcare insurance and government accumulate data about physician practices and patients care. It might save money for these stakeholders but there are no assurances that the saving will be passed on to either physicians or patients. The promise of the EMR is it should increase productivity and decrease practice overhead. Physicians should be able to decrease the number of full time employees. In most cases this does not happen.
3. Patient privacy is the third barrier. In reality, at this moment patient privacy is non existent with paper records. If patients want to buy healthcare insurance complete medical histories are required by the healthcare insurance company. An EMR would make it easier for the healthcare insurance industry to evaluate a patient record and restrict a patient’s access to healthcare insurance. The element of mistrust by physicians and patients toward government and the healthcare insurance industry is difficult to erase.
The point of patient mistrust was expressed in late June when a House of Representatives committee introduced new healthcare privacy legislation that does not adequately protect patient privacy. The American Civil Liberties Union was the first to protest.
“Leaders of the Energy & Commerce Committee introduced H.R. 6357 this week, and the health subcommittee approved it on June 26. The full committee, as well as two other House committees, now will consider the bill.”
“The legislation lacks provisions to enable patients to review their own files and make corrections, decide who has access to personal health information, or simply opt out, according to ACLU.”
Caroline Fredrickson, director of ACLU’s legislative office in Washington, said in a statement. “If this legislation gets approved, Americans’ medical secrets will be extremely vulnerable to being lost, stolen or sold to the highest bidder.”
I have stated previously that mistrust of the secondary stakeholders by the primary stakeholders in the healthcare system, physicians and patients, must be understood by healthcare policy makers. The issue of mistrust has to be resolved if any progress is to occur in accelerating physician adoption of the EMR.
Both the government and the healthcare insurance industry seem to encourage this mistrust unintentionally by introducing punitive measures to solve the healthcare systems’ problems. These measures simply heighten the primary stakeholders’ cynicism and mistrust.
More on EMRs to follow.